What Works: National rookie camp

ICRE recently spoke with Dr. Faizal Haji, Western University, about how faculty from a number of universities across Canada together developed a national rookie camp for their neurosurgical residents

Why did you develop a national rookie camp?

This isn’t my brainchild, I can’t take credit for it. The work comes from neurosurgical faculty from across Canada and was headed up by Dr. David Clark at Dalhousie University.

There was a meeting in Halifax in 2011 with faculty members and others about creating an introduction to neurosurgery to help ease the transition of graduates from medical school into residency. Often, graduates haven’t had a lot of independent responsibility for patient care prior to starting their residency training on July 1 and that expectation is suddenly there. Even though they receive support through the early years it can be a difficult transition.

There’s an interesting study by Phillips et al that documents an increase in medication errors in the month of July as compared to all of the other months of the year – so it’s not just an issue of stress for residents, it’s also a potential safety concern for patients. That’s why we’re focusing on transitions from medical school to residency and from residency to practice and making sure those transitions get smoothed out.

Our idea was to offer intensive training to help incoming residents catch up on basic skills, including technical and surgical skills all the way to communication and behavioral skills, and how to manage emergencies. Because we’re a small specialty – 17 residents across Canada last year – we decided to hold the intensive training in one location. The term “Rookie Camp” gives a certain flavour to the training.

How does your rookie camp differ from other intensive training models?

Our understanding is that this is the first national program of its kind. There are other introductory camps, of course. The University of Toronto runs an extensive program for all of its surgical residents, which runs for a month. That’s an example of an institution-specific program that’s offered across multiple programs. Ours is a specialty-specific program that has gone across institutions.

What is offered in your camp?

It’s a two-day camp that offers an introduction into neurosurgery training. The course utilizes both simulation and case-based learning. It was modeled after a similar course run in the U.S. but we revised the content to be specific around CanMEDS competencies and things we thought were important in Canadian neurosurgical training.

To help us develop the course, we did a needs assessment survey of neurosurgery Program Directors across Canada, the first-year residents at the time, and the potential participants in our camp. We had 38 out of the 54 possible participants who completed the survey. We asked them a series of questions about what specific technical, cognitive, behavior and communication skills and other CanMEDS competencies we should be covering in the camp. With their input, we came up with 10 stations.

Most of the stations are built around a clinical case, which is presented by the facilitator. Residents were broken up into groups and they rotated through the station in small groups of 3-4. The groups talk about the case and what they are concerned about and then progress to diagnosis and treatment. They can practise technical skills related to the case as well. The case is anywhere from 45 minutes to two-and-a-half hours, and is based on common clinical presentations. The residents get to walk through the case, and discuss all the significant issues associated with it, including anatomy, differential diagnoses, stabilization of the patient and finally surgical management options.

A few stations are just technically focused. This allows the residents to look at neurosurgical instruments and they get some exposure on how to use the instruments to perform a surgical technique. They also get to practice how to position a patient, how to fix their head, that sort of thing.

We also give participants a course manual. All of the faculty and some other neurosurgeons and residents across Canada contributed to writing chapters. The handbook gives residents an overarching framework on topics like: how do you communicate bad news; how do you deal with a neurosurgical emergency; what is your approach on a case of back pain?

What are some of the challenges to offering a rookie camp?

The camp isn’t designed to be comprehensive and cover all things. Nothing can replace the dedicated deliberate practice – what you do in the daily rehearsal during residency training. The expectation isn’t that residents come out of rookie camp and suddenly are experts. Our intent is to just give them basic tools to get started on the process, so that when they’re on call for the first time or during the first couple of months of training, they’re not feeling totally overwhelmed and they feel that they have some preparation for how to deal with difficult situations.

The other challenge is one of cost. There is an additional cost associated with transporting the residents from across Canada to Dalhousie. Sponsorships support the course, and each program covered the cost of travel expenses for their residents.

What have been the results?

Residents have been uniformly positive about the course. They enjoyed the experience and the social aspects of interacting with peers and neurosurgical faculty. In their evaluation, residents indicated they not only developed knowledge, they were also using some of the pieces they learned at rookie camp in their daily residency training.

What are your next steps?

The course has run for the last two years (July 2012 and July 2013), and will likely be annual.

The reality is that the two-day experience won’t revolutionize residents’ education but we believe that giving them this introduction enhances their ability to learn in the early stages of their training.

Currently, we don’t have historical data or a good sense of skill development through simulation training. There are traditional measurements through ITERS and a rotation evaluation. But the movement in medical education is to look at specific competencies and we would like to be a part of what others are doing in the larger community about assessing how we measure changes in performance and how to track the improvement through the training.